Prognostic value of Fibrosis-4 Index and preoperative dynamic changes in heart transplantation.
4 affiliations
- 1Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei 430022, China.
- 2Department of Cardiovascular Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, China.
- 3Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
- 4Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, No. 1095 Jiefang Avenue, Wuhan, Hubei 430022, China.
Abstract
Introduction
The Fibrosis-4 (FIB-4) Index has shown prognostic value in cardiovascular diseases, but its role in heart transplantation (HTx) and the impact of dynamic preoperative changes remain unclear. This study evaluated the prognostic value of preoperative FIB-4 for mortality after HTx and investigated whether dynamic changes in FIB-4 before transplantation are associated with post-transplant survival.Methods
This single-centre retrospective cohort study included 791 adult patients who underwent orthotopic HTx between January 2015 and December 2024, with follow-up through June 2025. Patients were stratified by preoperative FIB-4 into low (<1.30), intermediate (1.30-2.67), and high (>2.67) risk groups. The primary outcome was all-cause mortality. Analyses employed Cox models, restricted cubic splines, and five machine learning survival models, including Random Survival Forest (RSF).Results
During a median follow-up of 28.8 months, 218 patients (27.6%) died. Preoperative FIB-4 showed a non-linear association with mortality (inflection point: 2.03) and was an independent predictor of death [hazard ratio (HR) per unit increase, 1.04; 95% CI, 1.02-1.07; P < .001]. In the RSF model, FIB-4 was the most important prognostic variable (Variable Importance = 0.068), outperforming traditional donor and surgical factors. Sensitivity analyses confirmed that FIB-4's prognostic value was independent of age (interaction P = .745) and superior to its individual components (aspartate aminotransferase, alanine aminotransferase, and platelet count). Correlation analyses showed no significant association between FIB-4 and invasive haemodynamic parameters, tricuspid regurgitation severity, or MELD/MELD-XI scores, supporting its distinction from haemodynamic congestion. Among high-risk patients (n = 153), preoperative improvement in FIB-4 category was associated with significantly lower mortality (adjusted HR, 0.49; 95% CI, 0.29-0.82; P = .007). Preoperative use of glutathione was independently associated with FIB-4 improvement [odds ratios (OR), 1.50; 95% CI, 1.01-2.22; P = .04].Conclusion
Preoperative FIB-4 is a robust and independent predictor of post-transplant mortality, with greater predictive importance than traditional surgical risk factors. Dynamic improvement in FIB-4 before transplantation is associated with better survival. Integrating FIB-4 into routine preoperative assessment may refine risk stratification and guide pre-transplant management.
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BibTeX
@article{lai2026prognostic,
title = {{Prognostic value of Fibrosis-4 Index and preoperative dynamic changes in heart transplantation.}},
author = {Junlin Lai and Yazheng Shan and Wai Yen Yim and Kaixin Chen and Chenghao Li and Jincheng Hou and Yongbu Peng and Yuqi Chen and Tian Xia and Yuze Zheng and Tixiusi Xiong and Yijie Luo and Jing Zhang and Yin Wang and Yixuan Wang and Guohua Wang},
journal = {ESC heart failure},
year = {2026},
month = aug,
doi = {10.1093/eschf/xvag258},
url = {https://europepmc.org/article/MED/42921753},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Prognostic value of Fibrosis-4 Index and preoperative dynamic changes in heart transplantation.
AU - Junlin Lai
AU - Yazheng Shan
AU - Wai Yen Yim
AU - Kaixin Chen
AU - Chenghao Li
AU - Jincheng Hou
AU - Yongbu Peng
AU - Yuqi Chen
AU - Tian Xia
AU - Yuze Zheng
AU - Tixiusi Xiong
AU - Yijie Luo
AU - Jing Zhang
AU - Yin Wang
AU - Yixuan Wang
AU - Guohua Wang
PY - 2026
DA - 2026/08/01
JO - ESC heart failure
DO - 10.1093/eschf/xvag258
UR - https://europepmc.org/article/MED/42921753
AB - Introduction The Fibrosis-4 (FIB-4) Index has shown prognostic value in cardiovascular diseases, but its role in heart transplantation (HTx) and the impact of dynamic preoperative changes remain unclear. This study evaluated the prognostic value of preoperative FIB-4 for mortality after HTx and investigated whether dynamic changes in FIB-4 before transplantation are associated with post-transplant survival.Methods This single-centre retrospective cohort study included 791 adult patients who underwent orthotopic HTx between January 2015 and December 2024, with follow-up through June 2025. Patients were stratified by preoperative FIB-4 into low (<1.30), intermediate (1.30-2.67), and high (>2.67) risk groups. The primary outcome was all-cause mortality. Analyses employed Cox models, restricted cubic splines, and five machine learning survival models, including Random Survival Forest (RSF).Results During a median follow-up of 28.8 months, 218 patients (27.6%) died. Preoperative FIB-4 showed a non-linear association with mortality (inflection point: 2.03) and was an independent predictor of death [hazard ratio (HR) per unit increase, 1.04; 95% CI, 1.02-1.07; P < .001]. In the RSF model, FIB-4 was the most important prognostic variable (Variable Importance = 0.068), outperforming traditional donor and surgical factors. Sensitivity analyses confirmed that FIB-4's prognostic value was independent of age (interaction P = .745) and superior to its individual components (aspartate aminotransferase, alanine aminotransferase, and platelet count). Correlation analyses showed no significant association between FIB-4 and invasive haemodynamic parameters, tricuspid regurgitation severity, or MELD/MELD-XI scores, supporting its distinction from haemodynamic congestion. Among high-risk patients (n = 153), preoperative improvement in FIB-4 category was associated with significantly lower mortality (adjusted HR, 0.49; 95% CI, 0.29-0.82; P = .007). Preoperative use of glutathione was independently associated with FIB-4 improvement [odds ratios (OR), 1.50; 95% CI, 1.01-2.22; P = .04].Conclusion Preoperative FIB-4 is a robust and independent predictor of post-transplant mortality, with greater predictive importance than traditional surgical risk factors. Dynamic improvement in FIB-4 before transplantation is associated with better survival. Integrating FIB-4 into routine preoperative assessment may refine risk stratification and guide pre-transplant management.
SN - 2055-5822
ER -